772 PERCY FRIDEXBERG 



| 



physician to a mistaken diagnosis of acute systemic disease or even of 

 brain tumor. 



The symptoms of acute glaucoma may be summed up as those of cer- 

 vical sympathetic irritation, and the sudden incidence of an attack from 

 a single instillation of a weak solution of atropin, from a sudden emo- 

 tional stress, from exhaustion or exposure to cold, confirm this view. 

 Per contra, the efficacious therapeutic agents are all such as stimulate 

 the vagus system, and the operative procedure of removal of the superior 

 cervical sympathetic ganglion is the only one which completely inhibits 

 sympathetic irritation of the ocular functions. 



Clinical and Therapeutic Implications. The essentially anti-glau- 

 comatous alkaloids, the meiotics, are pro tanto vagotonic. Elimination 

 by heat, sweating, catharsis, as well as by the action of dionin, mercury, and 

 the iodids are valuable therapeutic agents whose beneficial action has 

 bee'n determined empirically rather than scientifically. Of each and 

 every one of these much of the effect is due to stimulation of one or other 

 organ of internal secretion or to checking expenditure of valuable in- 

 ternal secretion. The action of iodin as a thyroid activator is particularly 

 significant. Pilocarpin and eserin, besides contracting the pupil, and 

 thus allowing the iris to develop to the full its action as a filter while free- 

 ing the iris-angle, markedly increase ocular secretion and metabolism 

 generally. Morphin has the same pupillomotor action, and with heat 

 and coffee, tends to allay pain and anxiety and thus restore resistance and 

 cut down endccrin waste. The action of cathartics is likewise complex. 

 The elimination of intestinal products of decomposition which furnish 

 a source for toxins which are particularly deleterious to the thyroid and its 

 immunizing function, is but one of these. The mechanical effect of me- 

 chanical depletion of the gut and of elimination of large amounts of fluid 

 from the same area with the coincident derivative effect and the pos- 

 sibility of freer outflow of intra-ocular fluids must also be considered. The 

 neutralization of an intestinal or even systemic acidosis by cathartics alone 

 or assisted by alkalines or by the salicylates furnishes another factor. There 

 is need for careful study of the chemistry of the vitreous and intra-ocular 

 fluids in health and diseases to throw light on the question of varying 

 acidity in different states of tension. Leeching and massage which are 

 of undoubted value in glaucoma with severe pain act largely by mechanical 

 action, but it is impossible to exclude a coincident direct action on the 

 nerve-terminals in the iris and ciliary body tending to restore the normal 

 secretory balance. 



It is significant that meiotics are of the greatest usefulness and offer 

 the most favorable outlook for a lasting therapeutic effect in cases of 

 simple or non-inflammatory glaucoma, in which, it is fair to assume, the 

 endocrin disturbance has not been complicated by marked anatomic or! 

 mechanical features leading to obstruction of the filtration angle of the 



